Tracheal devices



May 7, 1963 E. B. NICHOLS TRACHEAL DEVICES 2 Sheets-Sheet 1 Filed May 4,1960 INVENTOR. .Edydrfi. M'afials ATTORNEY May 7, 1963 E. B. NICHOLSTRACHEAL DEVICES Filed May 4Q 1960 w B 2 w, 5

ATTOHIVEX 3,088,466 TRACHEAL DEVECES Edgar B. Nichols, 19 Colonial Ave,Moorestown, NJ. Filed May 4, 1960, Ser. No. 26,738 6 Claims. (Cl.l28-351) This invention relates to surgical appliances, and moreparticularly to tracheotomy tubes and the like, the present inventionbeing in the nature of an improvement over that disclosed in my earlierpatent, No. 2,765,792, granted October 9, 1956.

For persons whose respiratory function has been impaired by reason ofcertain throat or nasal defects, it is common practice for surgeons tomake an incision near the base of the afilicted patients throat and thusestablish communication between the ambient air and the patients tracheaor wind pipe. A tube known as a tracheotomy tube is then inserted intothe trachea through this incision to facilitate passage of air into thetrachea. Again, there are persons whose larynx may have become diseasedand removed by surgery, whereupon they lose the power of speech. Here,too, an incision is made in the throat for reception of a tracheotomytube in the trachea, an artificial larynx being connected to the tube toenable the afflicted person to speak once more.

Tracheotomy tubes of this sort come in pairs, one fitted within theother. The outer tube is inserted into the trachea and may be held inplace by means of a neckband. The inner tube is then slid into the outerone and, to prevent accidental removal therefrom, some sort of lockingmeans is usually employed for holding the two tubes together. The outertube usually remains in the trachea for relatively long periods, whilethe inner tube is removed frequently for cleaning. Such tubes werecustomarily made of various metals or of hard rubber. These materialshave numerous disadvantages from the standpoints of use, comfort,difiiculty to clean and sterlize, proneness to damage, cost, etc., asmore fully pointed out in my above identified patent. Thesedisadvantages are all avoided by making the tubes of certain synthetic,plastic materials, such as nylon, Lucite and the like, as proposed in myaforesaid patent. Tubes which are more or less resilient can be made ofthese plastic materials. By forming the innermost end of the outer oneof a pair of such tracheotomy tubes with a radially inwardly thickenedwall which is frictionally engaged by the lower or inner end of theinner tube, as taught in my aforesaid patent, the two tubes can be madeto engage each other firmly, by reason of the resilience thereof, whenthe inner tube is fully inserted into the outer tube. This avoids theneed for employing extraneous locking means to hold the two tubes inmated relation, yet permitting facile removal of the inner tube whennecessary. However, the inwardly thickened wall at the lower, inner endof the outer tube necessarily restricts or limits the diameter of theinner tube and, hence, the size of the passage provided threby.

The primary object of my present invention is to provide an improvedtracheotomy tube structure which will be free from the aforementionedlimitation.

More particularly, it is an object of my present invention to provide animproved tracheotomy tube structure the mating tubes of which, whileadapted to locking- 1y engage each other in mated relation, willnevertheless provide a passage of maximum diameter in the inner tubewhen considered with respect to the inner diameter of the outer tube.

Another object of my present invention is to provide an improvedtracheotomy tube structure which makes it possible to produce tubes withthinner walls than those considered feasible heretofore, therebyincreasing the capacity of the tubes.

Still another object of my present invention is to provide an improvedtracheotomy tube structure the tubes of which can be mated and separatedwith great facility, yet which will remain in firmly mated relation oncethe inner tube is inserted fully into the outer tube.

A further object of my present invention is to provide an improvedtracheotomy tube structure as aforesaid which will have a minimum weightfor a given size and which, therefore, will produce a minimum ofdownward pressure on the throat of the wearer.

One of the features of the tracheotomy tube structure of my aforesaidpatent is that a seal is provided at the lower ends of the tubes toprevent entry of mucous secretions or other liquids between the tubewalls. It is another object of my present invention to retain thisadvantage without the need for making the wall of the outer tube thickerat its lower or inner end, as in the tube structure of myabove-mentioned patent.

Yet another object of my present invention is to provide an improvedtracheotomy tube structure the tubes of which can be constructed tofirmly engage each other either adjacent the upper ends thereof oradjacent the lower ends thereof, when the tubes are in mated relation,to thereby releasably lock the two tubes in assembled relation andwhich, even when locked adjacent the upper or outer ends thereof, canstill provide an effective seal against entry of mucous or other liquidsbetween the two tubes at the lower or inner ends thereof.

Still another object of my present invention is to provide an improvedtracheotomy tube structure as above set forth the inner tube of whichcan be removed easily from the outer one without distortion and withminimum force.

A further object of my present invention is to provide an improvedtracheotomy tube which can withstand safely much mechanical abusewithout becoming deformed or otherwise damaged.

A still further object of my present invention is to provide an improvedtracheotomy tube structure which is extremely light in weight, which canbe put in place very easily by the user and removed, at will, with equalease, which will cause the wearer a minimum of discomfort, and which canbe cleaned and sterilized by well accepted methods without danger ofdamage thereto.

It is also an object of my present invention to provide an improvedtracheotomy tube structure as above set forth which can be manufacturedeasily, which will have a long life, which is sturdy in construction andwhich is highly eflicient in use.

In accordance with the present invention, the walls of the two trachealtubes are preferably made of uniform thickness along their lengths, butthe walls of either one or both tubes may be deformed somewhat toprovide one or more frictional locking elements. These elements, whichmay be annular ridges extending entirely around the tubes, or one ormore small protuberances or depressions, or one or more short,longitudinally extending ribs, or the like, may be formed at either theinner or the outer ends of the tubes. Where such deformations are formedin only one tube, they will frictionally engage the wall of the othertube to hold the tubes firmly in mated or assembled relation. Ifdesired, however, both tubes may be formed with complementary,cooperating protuberances which will engage each other when the twotubes are assembled. In either case, the two tubes will be releasablylocked to each other in assembled relation. If the tubes are formed withannular or Cila cumferential deformations at their inner ends, theengaging protuberances will provide a seal against entry of mucoussecretions between the tubes after the manner of the tube structure ofmy above-noted patent. However, since the wall at the lower end of theouter tube need not be thickened according to the present invention, incontrast to that of my aforesaid patent, the two tubes can be made tohave a fairly snug fit and thereby provide a mucous seal at their lowerends anyway. Preferably, therefore, the tube-locking deformations areformed at the upper or outer ends of the tubes. One way of accomplishingthis, for example, is by slightly enlarging the diameter of the innertube adjacent to its upper end. Other ways include the provision of theaforementioned deformations or enlargements on one or both of the tubesat their upper ends. By providing the locking deformations or elementsat the upper ends of the tubes, the tubes can be made of thin walls andwith maximum internal diameters whereby the capacities thereof will beincreased. At the same time, the force required to withdraw the innertube from the outer one is a minimum, thus making the improvedtracheotomy structure of the present invention easy to use and toservice.

The invention itself, both as to its organization and mode of use, aswell as additional objects and advantages thereof, will be more readilyunderstood from the following description of several embodimentsthereof, when read in connection with the accompanying drawings in whichFIGURE 1 is a perspective view of one form of outer tube of a pair ofcooperating tracheotomy tubes according to my present invention,

FIGURE 2 is a similar view of one form of inner tube adapted to matewithin, and cooperate with, the outer tube of FIGURE 1,

FIGURE 3 is a front view of the tubes of FIGURES 1 and 2 in matedrelation,

FIGURE 4 is a side elevation of the mated tubes of FIGURE 3 the outertube being shown partly broken away and in section to more clearly showthe relation of the two tubes when they are fully mated,

FIGURES 5, 6 and 8 are views similar to FIGURE 4, but showing variousother forms of tracheotomy tubes in accordance with my presentinvention,

FIGURE 7 is a fragmentary, sectional view showing a modified form of theembodiment of FIGURE 6,

FIGURE 9 is a fragmentary, sectional view showing a modified form of theembodiment of FIGURE 8,

FIGURE 10 is a side elevation, partly in section, of a modification ofthe tube structure of FIGURE 4 and with an adapter connected to theinner tube at the mouth thereof, and

FIGURE 11 is a view similar to FIGURE 10 but showing a somewhatdifferent form of adapter connected to the inner tube.

Referring more particularly to the drawings, wherein the same referencenumerals designate like parts throughout, there is shown, in FIGURES 1to 4, a tracheotomy tube structure comprising an outer tube 1 which iscurved longitudinally to conform to the shape of the upper end of thetrachea, and a correspondingly curved inner tube 3 which is insertableinto the tube 1 for nested, mating relation therewith. The outer tube 1is adapted to be inserted into the trachea through an opening formed inthe neck of the user. This is done in well known manner with the aid ofa suitable pilot or obdurator (not shown), after which the obdurator isremoved. The inner tube 3 is then inserted into the outer tube. Thetubes 1 and 3 are preferably made of synthetic materials which are lightin weight and which are immune from attack by mucous or other glandularsecretions of the body to help minimize any discomfort to which the usermight be subjected. Various synthetic resin materials more fully setforth in my aforesaid patent, and of which nylon is an example, aredeemed most suitable, especially since such materials possess resilienceuseful for a purpose presently to be set forth.

At its upper or entrance end as considered when it is within thetrachea, the outer tube 1 is formed with a 4 plate 5 which fits againstthe neck of the user. The plate 5 helps to conceal the incision oropening at the front of the neck when the tube 1 is fully inserted intothe trachea. The plate 5 has a pair of transverse slots 7 with which theclips of a neck band (not shown), as more fully described in myaforesaid patent, engage for retaining the tube 1 in place. The tube 3is formed with a funnellike mouth 9 at its upper or entrance end, thesmaller diameter end of the mouth 9 engaging the plate 7 when the tube 3is in fully inserted position within the tube 1.

Various means are provided, in accordance with the present invention, tomaintain the tubes 1 and 3 releasably locked to each other when they arein mated relation. Generally speaking, an enlargement on the surface ofthe inner tube 3 at some suitable point or points along its length forpressingly engaging the inner surface of the outer tube is employed forthis purpose. The resilience of the material of the tubes insuressuflicient pressure and/or friction between the inner tube enlargementand the other tube to maintain the two tubes suitably locked to eachother. The enlargement may be in various forms.

In the emobdiment shown in FIGURES 1 to 4, the enlargement comprises acircumferential collar 11 of slightly larger diameter than the outsidediameter of the tube 3 and molded integrally therewith adjacent to themouth 9. This collar is shown exaggerated in the drawings for the sakeof illustration. I have found that the collar 9 will be very effectiveif made of a thickness of only about to inch where the spacing betwenthe tubes is of the order of about 0.005 inch. This is because of theresilient character of the material of the tubes 1 and 3 whereby only aslight enlargement of the outside diameter of the inner tube issufiicient to obtain an effective locking engagement of the two tubes.Thus, the outside diameter of the inner tube 3 and the inside diameterof the outer tube 1 may be made such that the tube 3 can be freelyinserted into the outer tube -1 but with a close fit therebetween.Accordingly, for a given internal diameter of the outer tube 1, theinternal diameter of the inner tube 3 can be made fairly larger than waspossible with the tube structure of my aforesaid patent, therebyincreasing the capacity of the tracheal device. Moreover, the walls ofthe tubes can be made thinner to thereby further increase the capacity.If desired, the collar 11 may be formed on a slight taper to widen as itapproaches the mouth 9. This will assure a firmer grip between the twotubes when they are fully mated.

To release the grip between the tubes 1 and 3 and withdraw the innertube from the outer one, the index finger and thumb of one hand areplaced behind the tapered mouth in substantially diametrically opposedrelation with the nails of these digits against the plate 5. By thenforcing or wedging these digits in slightly toward the axis of the mouth9, the inner tube 3 can be readily forced out of frictional lockingengagement with the outer tube 1 for facile removal of the tube 3 fromthe tube 1.

In the form of the invention shown in FIGURE 5, the enlargement on theinner tube 3 is in the form of an outwardly protruding protuberance orbump 13 in proximity to the upper end of the tube 3. The outer tube 1may be formed with a complementary, hollow protuberance 15 which isaligned with the protuberance 13 when the tubes 1 and 3 are fully mated.The hollow protuberance 15 thus forms a seat which receives theprotuberance 13 to even more positively, yet still releasably, lock thetwo tubes together in mated relation. While only one pair of cooperativeprotuberances 13 and 15 has been shown in FIGURE 5, it will beunderstood that a plurality of such protuberances may be provided on thetubes 1 and 3 in circumferentially spaced relation therearound.

In FIGURE 6, the enlargement or protuberance takes the form of anoutwardly projecting, annular ridge 17 on the tube 3 in proximity to itsupper end. This ridge 17 frictionally engages the inner surface of thetube 1 by reason of the resilience of the material of the tubes. Al-

though the close fit between the tubes 1 and 3 at their lower ends, whenconstructed with the dimensions set forth above, usually suflices toprovide an effective mucous seal, it is sometimes desirable to provide amore positive seal. In such cases, the modification of FIGURE 7 isadvantageous. Here, the inner tube 3 is formed with the outwardlyprojecting, annular ridge 17 near its lower or inner end, and the outertube 1 is formed with a corresponding, complementary ridge 19 which ishollow internally for reception of the ridge 17. The cooperating ridges17 and 19 not only serve to releasably lock the two tubes together, butalso to provide a positive seal against the entry of fluid between thetubes. At the same time, this form of my present invention permitsmaking the tubes of maximum capacity.

Another form of locking enlargements is shown in FIG- URE 8. Here, theenlargements comprise one or more longitudinally extending ribs orflanges 21 which frictional-ly engage the inner surface of the tube 1.When, as illustrated in FIGURE 8, a plurality of ribs 21 are employed,they are distributed circumferentially about the tube 3, and they may beof graduated length to simplify insertion and removal of the tube. Ifdesired, corresponding protuberances 23 may be formed in the tube 1. Theribs 21 can then be received in the hollow protuberances 23 and seatedtherein as shown in FIGURE 9.

Sometimes, it is necessary to give a patient wearing a tracheotomy tubestructure of the type described above special treatment of one sort oranother. For example, it may be necessary to supply oxygen to him tofacilitate breathing, or to supply medication, and so on. In othercases, it may be necessary to connect an aspirator to the patient toremove fluids. For these and similar purposes, an adapter 25 of materialsimilar to that of the tubes 1 and 3 can be coupled to the inner tube 3.The form of adapter shown in FIGURE has three tubular inlets Z7 and asomewhat tapered, tubular outlet 29. The outlet 29 is formed with anoutwardly protruding, annular protuberance or ridge 31 similar to theridge 17 of FIG- URE 6. The ridge 31 frictionally engages the tube 3 atthe mouth thereof to be frictionally locked in place by reason of theresilience and dimensions of the involved parts. An aspirator can beconnected to one of the inlets 27, .a supply of oxygen to another, and asupply of medication to a third, each to be used as needed. The adapter25 can be removed easily by simply holding one hand against the mouth 9and pulling the adapter forwardly to release the hold at the ridge 31.

An adapter 25 having a single, tapered, tubular inlet, as shown inFIGURE 11, is sometimes useful in lieu of the multi-inlet adapter ofFIGURE 10. Here, again, the adapter is formed with an outwardlyprojecting ridge 31 which may be seated in .an annular groove 33 formedin the inner surface of the tube 3 adjacent the mouth thereof. Thisarrangement affords a somewhat more positive looking engagement betweenthe adapter 25 and the tube 3 while still permitting facile separationthereof.

Although I have shown and described several forms of tube structuresaccording to my present invention, it will be obvious that other,equivalent structures, as Well as variations in those described andshown, are possible within the spirit of the present invention. Itherefore desire that the foregoing shall be taken merely asillustrative and not in a limiting sense.

I claim as my invention:

1. A tracheal device comprising an outer tube adapted to be insertedinto the trachea of a user and having an entrance end for reception ofan inner tube therein, and

an inner tube insertable into said outer tube through said entrance endthereof to be mated therewith, said inner tube having a correspondingentrance end and a radial enlargement adjacent thereto adapted tofrictionally engage the inside surface of said outer tube when saidtubes are in mated relation to thereby releasably hold said tubes insaid mated relation.

2. A tracheal device according to claim 1 characterized in that at leastone of said tubes is of resilient material, characterized further inthat the inside diameter of said outer tube and the outside diameter ofsaid inner tube are such that said inner tube can be freely insertedinto said outer tube but with a close fit between said tubes, andcharacterized still further in that said inner tube enlargementpressingly engages said outer tube when said inner tube is mated withsaid outer tube, the pressing engagement of said enlargement with saidouter tube causing said outer tube to frictionally engage said innertube at said enlargement by reason of the resilience of said one tubewhereby to releasably hold said tubes in mated relation.

3. A tracheal device comprising an outer tube adapted to be insertedinto the trachea of a user and having an upper, entrance end and a lowerend when disposed in the trachea, and an inner tube insertable into saidouter tube through said upper, entrance end thereof to be mated innested relation therewith, said inner tube then also havingcorresponding upper, entrance and lower ends, said tubes havingcomplementary deformations within the bores thereof in proximity totheir said upper, entrance ends to engage each other when said tubes arein said nested relation to thereby releasably lock said tubes in saidrelation.

4. In combination, a tracheal device comprising an outer tube adapted tobe inserted into the trachea of a user and having an entrance end forreception of an inner tube therein, an inner tube insertable into saidouter tube through said entrance end thereof to be mated therewith andalso having an entrance end corresponding to said entrance end of saidouter tube, means comprising a radial enlargement on said inner tubeadjacent to its said entrance end for engaging said outer tube andreleasably locking said tubes in mated relation, and a tubular adapterinserted into said inner tube at its said entrance end, said adapteralso having a radial enlargement adapted to engage said inner tubewithin the bore thereof adjacent said entrance end thereof forreleasably locking said adapter to said inner tube.

5. The invention set forth in claim 4 characterized in that said innertube has a seat adjacent its said entrance end for reception of saidadapter enlargement therein to thereby releasably lock said adapter tosaid inner tube.

6. The invention set forth in claim 5 characterized in that at least oneof said inner tube and said adapter is of resilient material, andcharacterized further in that said adapter and said inner tubepressingly engage each other at said enlargement by reason of theresilience of said material whereby said adapter and said inner tube arereleasably locked to each other.

References Cited in the file of this patent UNITED STATES PATENTS2,765,792 Nichols Oct. 9, 1956 2,786,469 Cohen Mar. 26, 1957 FOREIGNPATENTS 810,517 Great Britain Mar. 18. 1959

1. A TRACHEAL DEVICE COMPRISING AN OUTER TUBE ADAPTED TO BE INSERTEDINTO THE TRACHEA OF A USER AND HAVING AN ENTRANCE END FOR RECEPTION OFAN INNER TUBE THEREIN, AND AN INNER TUBE INSERTABLE INTO SAID OUTER TUBETHROUGH SAID ENTRANCE END THEREOF TO BE MATED THEREWITH, SAID INNER TUBEHAVING A CORRESPONDING ENTRANCE END AND A RADIAL ENLARGEMENT ADJACENTTHERETO ADAPTED TO FRACTIONALLY ENGAGE THE INSIDE SURFACE OF SAID OUTERTUBE WHEN SAID TUBES ARE IN MATED RELATION TO THEREBY RELEASABLY HOLDSAID TUBES IN SAID MATED RELATION.